Fifty Years After Major Report, Surgeons General Work To End Smoking

This is TELL ME MORE from NPR News. I'm Michel Martin. In a few minutes, we will hear from a writer who considers herself savvy and well-informed, but until she went through it, she says she did not know anything about miscarriage. So she wrote about it to try to inform others of what it really is like. Here's something everybody thinks they know - that cigarettes kill, right? Everybody knows that. A quick look at the numbers might suggest that, since 1965, the rate of smoking has been cut in half from more than 40 percent to less than 20, and the fight against smoking seems to have some momentum.

The drugstore chain CVS recently made news with its decision to phase out selling tobacco products altogether. But to some, the numbers aren't low enough, so public health advocates are meeting with former surgeons general tomorrow to talk about further steps to help stop new smokers before they start. So joining us now are two former surgeons general - Dr. Regina Benjamin, who was appointed by President Obama, and Dr. Antonia Novello, who served under President George H. W. Bush. And they are both with us now. Welcome back to the program to both of you. Thank you both so much for speaking with us.

REGINA BENJAMIN: Great, thank you for having us.

MARTIN: Dr. Novello, are you there?

ANTONIA NOVELLO: Yes, I am.

MARTIN: All right, thank you so much for coming as well.

NOVELLO: Thank you so much.

MARTIN: So, Dr. Benjamin, let me start with you. Half a century ago, people still didn't believe - or maybe they weren't told - that smoking is dangerous, but the summit coincides with a new report from the acting surgeon general that shows that cigarette smoking affects the body in even more ways than we previously thought. Can you tell us a little bit more about that?

BENJAMIN: Yeah, actually we're having the summit to commemorate those 50 years ago where Dr. Terry released the first surgeon general's report on tobacco to warn people that cigarette smoking was dangerous and harmful to your health. And, as you said, we've come a long way since then, but we still have a long way to go. In spite of the fact that we have smoke-free policies, smoke-free areas, we decreased the rate of smoking, still, today, smoking is the number one cause of preventable death in this country. And so we need to close that loop. Every single day, 1,200 people die from cigarette smoking. Each one of those deaths is being replaced by two young smokers - we call them replacement smokers.

Ninety percent of all smokers start before the age of 18, 99 percent before the age of 26. If we can just convince our young people not to take that first cigarette before the age of 26, our next generation could be tobacco-free because they have less than 1 percent chance they'll ever start. So that's why we're teaming up - we, the former surgeon generals - teaming up with young people to start to raise awareness about how they can become tobacco-free.

MARTIN: Dr. Novello, could you pick up the thread there? You know, it's interesting that the data is just kind of all over the place with who is smoking and the level of education, certain ethnic groups are more likely to smoke than others, for example. I don't know that, you know, people know this, but that blacks and Hispanics are actually less likely to smoke - and Asians - than whites and then Native Americans and multiple race individuals. And I'm just curious if we know why that is.

NOVELLO: Well, it would be very hard to say why that is, but you have to look at the top honest advertisement. And I think advertisement is really doing a little bit of damage. If you realize that when Luther Terry put his report 50 years ago, the smoking rate was only 40 percent. Now we are at 18 to 20. But the issue is that we have been telling people things that they feel is not their business because they feel infallible. The new report shows that it's no longer just lung that you have to worry. You have to worry about 13 new cancers caused by tobacco. So from your mouth, to your throat, your larynx, your esophagus, your stomach, your kidney, your pancreas, your liver and even your bladder and in men now erectile dysfunction. We are getting to the point that there are so many more things happening that people have to understand in all these 50 years.

But what I think, if you advertise for women, they have to realize that if they smoke early in their pregnancy for first time, you might be able to have a baby with cleft palate. So it's not so much just dying from sudden infant death syndrome or just having a low birth weight baby. You are having a little bit of cleft palate, which is a visible finding of what you did when you smoke early. So we have still in spite of the lowering of the prevalence and incidents, you still have the propaganda. And this time, it's a little bit more subtle. It is in magazines. It's in convenient source. It's in the movies, and it's in the Internet. So they are touching the lives of adolescents, making them assume that at no time are they are going to be able to die, but now there are even chances of diabetes type 2 and even arthritis. So we have consequences of smoking that are bigger than 50 years ago, and we are the ones who have to be able to take it to the public in a way that is factual and data-affirmed.

MARTIN: Let me play a clip...

BENJAMIN: I'd like to just jump in...

MARTIN: Hold on. Let me just play a short clip here for - 'cause I actually have a clip from a new anti-smoking ad campaign - a public service campaign. I believe this is from the FDA, and I just wanted to get your reactions and if you think this is the kind of thing that would be on target. Let me play it.

MARTIN: So what about that, Dr. Benjamin? Do you think that's the kind of thing - I mean, clearly, it's aimed at younger people...

BENJAMIN: Right.

MARTIN: ...In a young person's voice. What do you think about that?

BENJAMIN: I love it because, you know, when I was in practice, I would talk about the fact that when I talked to young people, they're not interested in hearing about lung cancer or something way down the road. But when I talk to them about your teeth turning yellow, your skin wrinkling, they want to look good. They don't want to be ugly. So those are the kind of things that they're interested in. Back to your question about minorities and the very different ethnic groups - everyone's vulnerable now.

The marketing has really turned towards young people. Every day, $27 million is being used to market tobacco products. Many of those are marketing to 18 to 26-year-olds because it's illegal to market to 18 and under. But you're seeing marketing in ways that we just don't even think about - subtle ways. Over 20 percent of the movies made for children have tobacco images in them, for example, the movie "Shrek." "101 Dalmatians" had Cruella de Vil smoking. "Avatar" - all of these have smoking images, and they're all there for the whole purpose of getting this new generation to start smoking.

MARTIN: Interesting. Dr. Novello, can I give you the final word here? Do you...

NOVELLO: Sure.

MARTIN: I was curious if you think that we'll be able to cut the smoking rate even further or you think it's plateaued.

NOVELLO: I have the feeling that if we continue to do what is right, the data has to be accurate, it has gotten to the people who needs to know it and we really have to make able to be available in the language that could be understood. But more than anything, remember that it has been tied to a little bit of interference in studying because the kids who smoke seems to be prepared to be able to need more help in whatever they do.

I believe that if you go on tap, you agree to be a mother with a normal child. If you are able to tap that when you smoke, it's almost like licking an ashtray. When you are able to tell people that they will be interfering with their sexual life with erectile dysfunction, you're getting to the things that are hurting, more than anything, the perception of the adolescent. So we cannot stop because the tobacco company has $35 billion a year to be able get advertisement which would be the equivalent of $6,000...

MARTIN: OK.

NOVELLO: ...For every death they have caused.

MARTIN: We...

NOVELLO: So we should be more strong than them.

BENJAMIN: You can't make that...

MARTIN: We have to leave it there. Forgive me. Forgive me, doctors, both of you. We're so sorry that we have to leave it there for now.

BENJAMIN: Thank you.

MARTIN: Former surgeon general, Dr. Antonia Novello and Dr. Regina Benjamin - both former surgeons general with us from member station WWNO in New Orleans. Doctors, thank you so much for taking the time.